Provider Demographics
NPI:1336206218
Name:FORD, DONNA KAYE (LPC)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:KAYE
Last Name:FORD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 480
Mailing Address - Street 2:
Mailing Address - City:NORRIS
Mailing Address - State:TN
Mailing Address - Zip Code:37828-0480
Mailing Address - Country:US
Mailing Address - Phone:901-581-3885
Mailing Address - Fax:865-494-7496
Practice Address - Street 1:103 HILLTOP LANE
Practice Address - Street 2:
Practice Address - City:NORRIS
Practice Address - State:TN
Practice Address - Zip Code:37828-0480
Practice Address - Country:US
Practice Address - Phone:901-581-3885
Practice Address - Fax:865-494-7496
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2094101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional